ACL Reconstruction: Allograft vs. Autograft

ACL Reconstruction:  Allograft vs. Autograft

By Erik Bassett, DPT

Recently, we posted a blog titled “Everyday People Rehabbing Major Knee Injuries with AZOPT.”  In this two part series, we focused on the rehab following a major tear in the ligaments of the knee.  In this scenario, AZOPT patient Josh had a surgical procedure known as an auto graft to repair the tears.  Many people wrote us wondering what exactly an autograft procedure is. 

First, just to refresh the memory, the ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) are inside the knee joint connecting the femur (thigh bone) to the tibia (large bone of the lower leg). The ACL and PCL form an “X” inside the knee that stabilizes the knee against front-to-back and back-to-front forces.  ACL tears occur approximately 200,000 times each year in America, of which nearly half require reconstruction.

There are two types of reconstructive surgeries to repair an ACL - allograft and autograft.  An allograft is a tendon used from something other than the individual patient, usually a cadaver.  An autograft is tendon used from the individual, usually the hamstring or patellar tendon.   What is the difference between the two types of reconstructive options, and is one better or worse than the other?  There are positives and negatives to each type of reconstructive surgery.

This year, The American Journal of Sports Medicine performed a meta-analysis, the best form of research, reviewing many articles on the subject written between 1999 and 2012[1].  According to the study, patients who received an autograft scored higher on a scale that rates common complaints of the knee.  Further, they report positive outcomes on a subjective report and positive results with a single leg hop test.  Comparatively, patients receiving an allograft report a positive return to pre-injury activity level along with a positive subjective report.  They also report positive results with a pivot shift and decreased anterior knee pain.  However, patients with an allograft procedure had a 3-fold increase in re-rupture rates compared to autografts.    

In March of 2011 I experienced a major ACL tear that required reconstruction.  I chose to have an allograft performed mainly due to the shortened length of recovery time.  With an allograft, there is a decreased recovery time due to smaller amounts of cutting other structures like the patellar and hamstring tendons.  While the recovery time is less with an allograft, after 12 months of rehabilitation both types of grafts result in equal knee range of motion, strength, and activity level if proper rehabilitation occurs.  To this day I am able to perform each and every activity the same as before my ACL reconstruction.  Occasionally, I experience only minimal pain after activity and mild aches during cooler weather. 

Rehabilitation is key to any ACL reconstruction.  Physical therapy is performed after an ACL reconstruction to enable the knee to recover in a timely manner.  Initial treatment following ACL reconstruction includes increasing range of motion both in flexion and extension, mild strengthening of knee and hip musculature, pain and swelling reduction using modalities, and soft tissue mobilization to increase tissue extensibility.   Crutches and a locked knee brace are typically used for the first 3 or 4 weeks.  As rehabilitation progresses, an increased amount of strengthening occurs.  It is important to strengthen the surrounding muscles to help support the ACL graft.

If you have ruptured your ACL and require a reconstruction, speak with your physician.  Generally, they will refer you to a surgeon for a consultation.  The surgeon will speak to you regarding the option for an allograft or an autograft.  Now that you know the difference between the two you can impress the surgeon with your knowledge.  Choose which type would be most beneficial for you in the long run.  When the operation is complete, call AZOPT to begin the rehabilitation process.  Good luck and happy recovery!

[1] American Journal of Sports Medicine. 2013 Apr 12. Bone-Patellar Tendon-Bone Autograft Versus Allograft in Outcomes of Anterior Cruciate Ligament Reconstruction: A Meta-analysis of 5182 Patients. Kraeutler MJ, Bravman JT, McCarty EC.

AZOPT Follow Up: Rehabbing Major Knee Injuries

AZOPT Follow Up: Rehabbing Major Knee Injuries

ACL injuries are a scary thing to see when they happen to athletes on television.  We see them writhing in pain, clutching their leg with tears rolling down their face.  An ACL injury to an athlete is season ending, potentially even career ending.  The rehabilitation is gruesome, tedious, and long.  But professional athletes have teams of doctors, physical therapists, trainers, and coaches to help them get back to 100 percent.  Not to mention their rehabilitation becomes a full time job.  That’s why, over time, most athletes bounce back from major ACL injuries. 

What about the common, middle-aged, weekend athlete?  In February, we posted an article Everyday People: Rehabbing Major Knee Injuries with AZOPT.  In that blog we met Josh, who suffered a grade 3 tear of his ACL and MCL, along with torn meniscus and bone bruising while practicing Judo with another adult in his son’s class.  A 35 year old father of three, Josh was an active person who participated in CrossFit, Judo, bike riding, and golf.  Josh had successful surgery on January 14, 2013 to repair his torn ACL, and he began physical therapy at AZOPT on January 23, 2013 with Ryann Roberts, DPT and Owner.

We interviewed Josh upon completion of his physical therapy March 8, 2013:

Your first appointment following surgery was January 23, your last March 8.  What was the focus of your rehabilitation during that time?

I attended physical therapy three times per week during that time.  We focused on strengthening, stretching, and balancing.  Strengthening exercises included squats, first with both legs, and then one leg at a time.  I also did various lunges and calf raises.  Stretching exercises were aimed at regaining range of motion with physical manipulations, static holds, and soft tissue massages.  The balancing exercises helped improve coordination by standing on one leg and throwing objects, or rocking on a tilted surface.  With going to physical therapy three times each week, I was pretty sore.  At home I tried to get good rest and kept up with stretching exercises Ryann had given me.

How helpful was physical therapy?

Physical therapy was very helpful as the first part of my recovery process.  Physical therapy took me from barely being able to walk to now (May 1) re-entering CrossFit and engaging in fairly rigorous physical activity.

On March 8, at your last physical therapy appointment, how far along were you in your complete rehab?

My rehab was progressing along nicely.  I had just been cleared to return to jogging and strengthening exercises, but not athletic type movements.  At the time, I felt I was ready to go off on my own and continue to rehab.  Ryann had given me a thorough home exercise program that included strengthening, stretching, and balance exercises. 

As of today, how far along are you in your rehab process?

My doctor has just cleared me to gradually return to sport-like activities.  I am participating in a form of modified CrossFit.  My doctor has just cautioned me to proceed slowly as my strength and coordination return.

What do you feel, if any, is the difference in rehabbing your knee with Ryann as oppose to anywhere else?

Ryann was an excellent fit for me.  His own athletic background gave him a unique perspective to appreciate my goals.  His more than capable oversight helped me achieve my best recovery possible.  My doctor has told me my knee represents their hope in all patients and is a best-case scenario. 

In our first article, we talked about your mental state and how faith has played an important role in accepting this injury and moving forward.  Having gone through the rehab now, what can you tell others about your experience?

The last seven months have been an unexpected sequence of events beginning with my injury then dealing with the consequences of the injury including doctor's appointments, rest, rehab, surgery, more rehab, etc.  Each of these has been accompanied with frustration, inconvenience, monetary expenditure, and physical pain and discomfort.   That is the honest reality of getting your leg snapped in two.  However, with that said, the thing that stands out most clearly is how fortunate I am.  God has been good to me.  I have received constant love, care, and encouragement from my family.  I was blessed to receive exceptional medical care from my doctor and the team over at AZOPT, and I have been blessed by the time and place I live so that I now have a reconstructed knee.  Think about how incredible this is.  Doctors used a portion of my hamstring muscle to recreate ligaments in my knee and because there were only minor incisions paired with modern medical techniques I will have a knee capable of returning to play in the NFL--pretty good for a middle-aged guy who is just trying to keep in shape and have an active life with my kids!  I have a lot of which to be thankful.